To Improve Food Inspections, Change the Way They’re Scheduled

Executive Summary

Food-borne illness affects an estimated 48 million Americans every year resulting in 3,000 deaths and the hospitalization of 128,000 people, according to the Centers for Disease Control and Prevention (CDC). Beyond that, foodborne illness in the U.S. is enormously costly, with an estimated collective annual bill of $55 billion in medical treatment, lost productivity and lost wages, not to mention litigation expenses. Given this immense impact, authors embarked on a research project to try to find ways to improve how local government inspectors handle their daunting task of ensuring that restaurants, hospitals, schools, and supermarkets prepare food safely. These inspections are conducted in much the same way as they have been for decades. The research suggests that they should focus on more thoughtful scheduling as a way to improve outcomes.

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Food safety doesn’t provoke the same level of public outcry as gun violence and drug addiction, but it is nonetheless a deadly serious epidemic. Food-borne illness affects an estimated 48 million Americans each year, resulting in 3,000 deaths and the hospitalization of 128,000 people, according to the Centers for Disease Control and Prevention (CDC). Beyond that, food-borne illness in the U.S. is enormously costly, with an estimated collective annual bill of $55 billion in medical treatment, lost productivity, and lost wages, not to mention litigation expenses.

Given this immense impact, we embarked on a research project to try to find ways to improve how local government inspectors handle their daunting task of ensuring that restaurants, hospitals, schools, and supermarkets prepare food safely. These inspections are conducted in much the same way as they have been for decades. Up until now, the biggest innovation in this area was a rule that some cities introduced over the past 20 years requiring restaurants to post grade cards indicating whether their latest inspection merited an A, B, or C. Indeed, this simple transparency mandate has led many restaurants to clean up their act.

And yet people are still getting sick — suggesting that there are still violations and other trouble spots that go undetected (or unaddressed when they are detected). We wanted to figure out how to help inspectors catch even more violations. And we wanted to know if insights from the study of behavioral operations — which examines the role of human behavior in operations management decisions — could help inspectors be more effective.

Inspection Bias

It’s important to emphasize that we have found that inspectors strive to be diligent, consistent, and fair. They take their jobs very seriously and believe strongly in their mission of protecting public health. But inspectors, like the rest of us, are human, and our research, which is forthcoming in the academic journal Management Science, revealed that their schedules can affect inspection quality.

When done correctly, a food-safety inspection is a painstaking process. We noticed that inspectors tended to cite fewer violations at each successive establishment they visited through their day — suggesting that the onerous work takes a toll on their meticulousness. When they spent more time on inspections earlier in the day, they cited fewer violations later. And, when inspections risked prolonging their work past their normal quitting times, they cited even fewer violations. This isn’t intended to insinuate that inspectors become lazy. Rather, it demonstrates that inspections are exhausting to conduct.

One solution to reduce the frequency of lower-scrutiny inspections is to distribute inspections more evenly over the course of a week to avoid “crunch days.” In other words, instead of scheduling three site visits on one day followed by a day in the office with perhaps only one inspection, assign two inspections and some office work on each day. Another solution: avoid late-afternoon inspections that risks prolonging inspectors’ shifts.

Inspectors can also mitigate the potential consequences of these biases. For example, we suggest scheduling inspections at the highest-risk and most trouble-prone facilities in the mornings. Early visits to venues such as elementary school cafeterias or assisted living facilities would enable inspectors to apply their highest scrutiny to venues where students and these residents — those especially vulnerable to the risks of food poisoning — would benefit.

Sequence matters for another reason, too: We found that an inspector’s experience at one establishment affected their scrutiny at the next one. For example, inspectors who encountered many violations or worsening trends at a first location tended to intensify their next inspection, leading them to cite more violations, whether the second visit happened the same day or the next. We suspect that these “outcome effects” resulted from inspectors’ frustrations over their perceptions that food establishments were neglecting food safety practices, which triggered a sense that they needed to be even more diligent.

Given these findings, what can inspectors do? Two thoughts occur to us: Reminders of noncompliance could significantly increase the citations. Moreover, to ensure that inspections of schools and other places that serve vulnerable populations are done as well as possible, they could be scheduled to take place immediately after establishments expected to have many violations. We imagine there are other ways to encourage inspectors to bring the same zeal to every inspection.

Likely Improvements

With one-million food-handling establishments to monitor across the United States, food-borne illness is a challenging and insidious foe to overcome. But if we modify the inspection system to account for the behavioral factors we identified, we believe we could significantly reduce food safety risks. If we are able to halve the daily schedule effects (which erode scrutiny) and increase by 50% the outcome effects (which increase scrutiny), we estimate that citations would increase by 5.5%, which translates to nearly 127,000 more violations detected each year. We estimate that this would result in 10 million fewer food poisoning cases and nearly 27,000 fewer food-related emergency room trips. The financial impact would also be dramatic, reducing food-borne illness costs by $7 billion to $16 billion per year.

Ultimately, understanding and addressing these inspection biases can improve oversight not only of restaurants, schools, hospitals, and supermarkets but also sites where food and drugs are manufactured and in a host of other contexts, such as environmental and occupational safety compliance and manufacturing and service operations quality control. Scheduling can be a simple and powerful tool to improve outcomes.

Maria R. Ibanez is an assistant professor at the Kellogg School of Management at Northwestern.